tbuckley/cabot-search huggingface dataset:
Abstract 11496: Radial Access for Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
Authors: Bahadir Simsek, Sevket Gorgulu, Spyridon Kostantinis, Judit Karacsonyi, Khaldoon Alaswad, Niranjan Reddy, Farouc A Jaffer, Darshan Doshi, Jaikirshan Khatri, Laura Young, Paul Poommipanit, OMER GOKTEKIN, Oleg Krestyaninov, Rhian Davies, Ahmed El Guindy, Jimmy Kerrigan, MITUL P PATEL, Basem Elbarouni, Stephane Rinfret, Wissam Jaber, William Nicholson, Philip Dattilo, Nidal Abi Rafeh, MD, FACC, Bavana V Rangan, Olga Mastrodemos, Salman S Allana, M Nicholas Burke, MICHAEL KUTUZIS, Emmanouil S Brilakis
Journal: Circulation (2022)

Introduction: Use of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has been increasing. Methods: We examined the clinical characteristics and procedural outcomes of patients who underwent CTO PCI with radial versus femoral access in the Prospective Global Registry for the Study of CTO Intervention (PROGRESS-CTO, NCT02061436). Results: Of 10,954 patients who underwent CTO PCI at 55 centers in 7 countries between 2012 and 2022, 2,578 (24%) had a radial-only approach. Patients who underwent radial-only access were younger (63 ± 10 vs. 65 ± 10, years, p&lt;0.001), more likely to be men (84% vs. 81%, p=0.001), and had a significantly lower prevalence of comorbidities compared with the femoral group, including diabetes mellitus (39% vs. 45%, p&lt;0.001) and coronary artery bypass graft surgery (57% vs. 64%, p&lt;0.001). In addition, radial-only cases had lower angiographic complexity with lower J-CTO (2.0 ± 1.3 vs. 2.5 ± 1.2, p&lt;0.001) and PROGRESS-CTO (1.2 ± 1.0 vs. 1.3 ± 1.0, p&lt;0.001) scores. After adjusting for potential confounders, radial-only access was associated with a lower risk of access site complications (odds ratio [OR]: 0.45, 95% confidence interval [CI], 0.22-0.91), similar technical success (OR: 0.87, 95% CI, 0.74-1.04) and major adverse cardiovascular events (MACE) (OR: 0.65, 95% CI, 0.40-1.07), compared with the femoral access group (Figure 1). Conclusions: Radial-only access was used in 24% of CTO PCIs and was associated with lower access site complications, and similar technical success and MACE compared with the femoral access group.
Abstract 11179: Changes in Cardiomyocyte Structure on Endomyocardial Biopsy Following COVID-19 Infection
Authors: Cara E Saxon, Amber A Berning, Michael R Bristow, Natasha Altman
Journal: Circulation (2022)

Case Presentation: A 24-year-old unvaccinated male with a history of NYHA Class II heart failure and morbid obesity presented with 4 days of chest pain and shortness of breath, and was found to have COVID-19 pneumonia. History included non-ischemic cardiomyopathy (NICM) with an LVEF of 33%. Troponin was 40 ng/L (ref &lt;=53 ng/L) and NT pro-BNP 1915 pg/mL (ref &lt;125 pg/mL). TTE showed LVEF 18.5% with severe global hypokinesis. As a participant in a clinical trial investigating heart rate modulation in NICM, 106 days prior to his positive COVID-19 PCR he had an endomyocardial biopsy (EmBx) revealing unremarkable myocytes (Figure 1A &amp; B). His end-of-study EmBx (118 days after COVID-19 infection) showed scattered hypertrophic cardiomyocytes with enlarged hyperchromatic nuclei and T-tubule dilation (Figure 1 C &amp; D). Discussion: Recent studies have described several types of myocardial injury related to COVID-19 infection. This is the first report to compare myocardial histopathological findings pre- and post-infection. The post-infection EmBx demonstrating cardiomyocyte hypertrophy and T-tubule dilation along with worsening LVEF on TTE were associated with progressive myocardial dysfunction following a recent COVID-19 infection. T-tubule changes have been correlated with abnormal cardiomyocyte contractile mechanics in animal models, although not previously described in relation to COVID-induced myocardial dysfunction. Limitations include the duration between his infection and biopsy as well as receipt of a study drug (ivabradine or placebo), though unlikely to impact the histopathology results. Figure 1: Endomyocardial histology and electron microscopy (EM) findings A, Pre-COVID with minimal pathologic findings (100x, H&amp;E); B, Pre-COVID EM with normal intercalated disc (arrow) and mitochondria (arrowhead); C, Post-COVID with scattered hypertrophic cardiomyocytes (100x, H&amp;E); D, Post-COVID EM with t-tubule dilation (arrows)
Abstract 11477: Assessing New Onset of Atrial Arrhythmia in Patients Undergoing Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy
Authors: Ryan Moore, Molly Silkowski, William C Mostertz, Matthew Evans, Chris Nielsen, VALERIAN Fernandes
Journal: Circulation (2022)

Introduction: Alcohol septal ablation (ASA) is an effective percutaneous procedure used to treat refractory hypertrophic obstructive cardiomyopathy (HOCM). ASA relieves left ventricular outflow tract (LVOT) obstruction by creating a targeted infarction in the septal muscle. Diastolic dysfunction and mitral regurgitation are responsible for increased left atrial pressure which contributes to left atrial ectopy. We seek to assess the incidence of atrial arrhythmias post-ASA and identify predictors to risk stratify these patients. Methods: Using a patient database maintained internally, 144 consecutive patients who underwent ASA for HOCM between March 2017 and February of 2022 at MUSC were retrospectively reviewed. Patients were selected based on the need for cardiac event monitoring after ASA. Patients were retrospectively analyzed for a previous history of atrial fibrillation (AF) as well as a new onset of AF after ASA. SPSS statistics was used for statistical analysis. Results: A total of 31 patients met final inclusion criteria. During the monitored time, seven patients (22.58%) developed a new onset of AF after ASA. Patients who developed AF post-ASA were found to have a statistically higher left atrial end-systolic volume index (LAESVi, mL/m 2 ) and left ventricular end-diastolic pressure (LVEDP, mmHg) (59.96 ± 8.93, 34.33 ± 11.54) when compared to those who did not develop AF (41.13 ± 13.93, 23.33 ± 9.06 (p=0.0003, p=0.0331)). Conclusions: In this high-risk proportion of patients who required cardiac monitoring post-ASA, there is a higher-than-expected risk for new onset of AF. The left atrial size and left ventricular filling pressures before ablation were the only significant predictors for development of atrial arrhythmias after ASA. Longer-term evaluation will be able to address if the expected reduction in atrial size and LVOT gradient after ASA will reduce the overall long-term burden of atrial arrhythmias.
Abstract 11331: Correlations Between Coronary Artery Calcium From Non-Gated Computed Tomography and Conventional Estimates of Peri-Operative Risk by Age and Sex
Authors: Dena Hayes, Daniel Choi, Samuel D Maidman, Nehal Dhaduk, Robert Donnino, Nathaniel R Smilowitz
Journal: Circulation (2022)

Introduction: Perioperative risk estimation prior to non-cardiac surgery is a common clinical challenge. Coronary artery calcification (CAC) is more common in men and older individuals. We sought to determine if an index of coronary calcium derived from pre-operative non-gated chest computed tomography (CT) is associated with conventional estimates of peri-operative risk in subgroups by age and sex. Methods: We retrospectively identified men and women age ≥45 years who had undergone non-cardiac surgery at a large urban health system between 2016 and 2020 and had a non-gated chest CT within 1 year prior to surgery. Coronary calcium in each coronary artery (LAD, LCX, RCA) was graded as absent, mild, moderate, or severe with a corresponding numeric score (range: 0-3). A novel coronary calcium index (CCI) was determined as the sum of these scores. Correlations between the CCI and Revised Cardiac Risk Index (RCRI), a conventional measure of perioperative risk, were assessed in subgroups by age and sex using Spearman's correlation coefficient (𝜌;). Results: Among 2,560 patients, 49.8% (1,273) were female and 60.0% (1,538) were ≥65 years old. The CCI exhibited a correlation with RCRI in men (𝜌;: 0.204, p&lt;0.001) and women (𝜌;: 0.200, p&lt;0.001), with no differences by sex (p=0.95). Correlations between the CCI and RCRI were also observed in younger (age 45-64 years; 𝜌;: 0.180, p&lt;0.001) and older (age ≥65 years; 𝜌;: 0.204, p&lt;0.001) adults, with no differences by age group (p=0.53) Conclusion: An index of coronary calcium derived from non-gated chest CT imaging prior to surgery correlated with RCRI among all subgroups by age and sex. Coronary calcium from non-gated imaging represents a potentially promising approach to pre-operative risk evaluation.
Abstract 11428: A Comparison Between Endothelin Receptor Antagonists and Renal Denervation for Resistant Hypertension: A Systematic Review and Meta-Analysis of Sham and Placebo Controlled Trials
Authors: Mohammad Ahmed, Rahul Bussa, Matthew Nudy, Andrew Foy
Journal: Circulation (2022)

Introduction: Endothelin-1 causes vasoconstriction by activation of calcium flux in smooth muscle cells. Use of endothelin receptor antagonists (ERAs) has remained controversial. Renal denervation (RD) has also been investigated as a treatment option for resistant hypertension (RHTN). The efficacy of these two novel treatment strategies was compared. Methods: Placebo-controlled and sham-controlled randomized clinical trials testing ERA or RD as treatments for RHTN were selected. Prespecified subgroup analyses comparing the efficacy of ERA and RD were conducted for outcomes of 24-hour (hr) blood pressure (BP) and office BP. Results: Nine studies (3 ERA and 6 RD) were identified that included 1,708 participants (816 ERA and 892 RD). Cochran risk of bias assessment showed 72% of the domains to be low risk of bias for the ERA studies and 88% of the domains to be low risk of bias for the RD studies. The raw mean difference (RMD) between ERA and placebo control was statistically significant for 24-hr systolic (SBP) (-8.34 mmHg; 95% CI -11.51 to -5.81, 24-hr diastolic (DBP) (-6.77 mmHg; 95% CI -8.90 to -4.63), office SBP (-4.50 mmHg; 95% CI -6.92 to -2.08), and office DBP (-2.01 mmHg; 95% CI -2.13 to -1.88). The RMD between RD and sham control was not statistically significant for 24-hr SBP (-1.85 mmHg; 95% CI -3.88 to 0.18), 24-hr DBP (-0.67 mmHg; 95% CI -1.84 to 0.51), office SBP (-1.93 mmHg; 95% CI -5.17 to 1.31), and office DBP (-1.55 mmHg; 95% CI -3.43 to 0.33). The interaction between the treatment subgroups was statistically significant for 24-hr SBP and DBP, but not for office SBP and DBP. Discussion: ERAs had greater reduction in 24-hr and office BP compared to RD among patients with RHTN. Despite efficacy in reducing BP in RHTN, use of ERAs remains controversial given the cost and side effect profile. RD does not reduce BP among patients with RHTN. Medications are the optimal treatment for RHTN and sham controlled data showing efficacy is needed prior to widespread use and adoption of RD in RHTN.
Abstract 11065: Stress T1 Mapping Demonstrates Coronary Microcirculatory Dysfunction in Both Nonhypertrophied and Hypertrophied Myocardium of Hypertrophic Cardiomyopathy
Authors: Hisanori Kosuge, Shoko Hachiya, Yasuhiro Fujita, Satoshi Hida, Taishiro Chikamori
Journal: Circulation (2022)

Introduction: Coronary microcirculatory dysfunction (CMD) in hypertrophic cardiomyopathy (HCM) is associated with clinical deterioration. We have shown that stress T1 mapping could detect CMD of hypertrophied interventricular septum (IVS). However, CMD in nonhypertrophied left ventricular free wall (LVFW) has not been fully elucidated. Hypothesis: We assessed the hypothesis that regional CMD in LVFW of HCM can be detected using stress T1 mapping. Methods: We evaluated 36 consecutive subjects (26 HCM patients and 10 control subjects, mean age: 61±3 years) who underwent CMR at 3T. Cine imaging, rest and adenosine stress T1 mapping, late gadolinium enhancement (LGE) and phase-contrast imaging of coronary sinus flow were performed. The T1 values at rest and after adenosine stress were measured as an averaged T values of 3 short-axis slices of LV myocardium and T1 reactivity (ΔT1) was calculated as follows: ΔT1 (%) = (T1stress - T1rest)/T1rest х 100. Coronary flow reserve (CFR) was measured coronary sinus blood flow during adenosine stress divided by that at rest. Results: The T1 values at rest were significantly higher in HCM than control (1245±9ms vs. 1196±11ms, p=0.0027), and the T1 values after adenosine stress significantly increased in both groups (HCM: 1285±10ms, p=0.0018 vs. rest, control: 1244±9ms, p=0.0128 vs. rest, Figure 1). Both IVS and LVFW demonstrated significantly lower ΔT1 in HCM than control (IVS: 3.95±0.35% vs. 5.68±0.41%, p=0.0163, LVFW: 4.80±0.39% vs. 6.75±0.65%, p=0.0163, Figure 2). CFR in HCM significantly decreased than that in control (2.48±0.40 % vs. 5.97±1.31 %, p=0.0051). Multiple regression analysis revealed that ΔT1 of both IVS and LVFW was correlated with CFR (β=0.527, p=0.0026, β=0.445, p=0.0325). Conclusions: T1 reactivity significantly decreased in both nonhypertrophied and hypertrophied myocardium of HCM compared to control. Stress T1 mapping have the advantage of being able to estimate regional CMD in addition to global CMD.
Abstract 11679: Simple Text-Messaging and Social Support to Increase Hypertension Medication Adherence in Non-Hispanic Black Adults in New Orleans, LA
Authors: Tina K Reddy, Daphne P FERDINAND, Madeline Wegener, Pavan Guduri, Saihariharan Nedunchezhian, John Lefante, Keith C Ferdinand
Journal: Circulation (2022)

Introduction: Non-Hispanic Black adults (NHB) have the highest US CVD risk, the leading cause of mortality. Medication nonadherence predicts suboptimal HTN control. Self-measured blood pressure (SMBP) effectively tracks BP changes and medication response. Purpose: This New Orleans, LA predominantly NHB single cohort pilot study examined uncontrolled HTN utilizing bidirectional electronic messaging (BEM) with an interdisciplinary healthcare team assessing medication adherence, quality of life (QOL), and BP, without pharmacotherapeutic change. Methods: Participants were screened from Tulane Cardiology Clinic and community sources. Eligibility criteria included: uncontrolled HTN (BP &gt;130/80 mmHg), low Krousel-Wood (KW) adherence score, and smartphone access. Participants (n=36) were provided validated bluetooth-enabled BP devices synced to smartphones via a cloud-based BP recording app. Demographic information included: age, self-identified race (91.7% NHB), and sex. Pre- and post-study KW adherence scores, CDC Health Related QOL surveys, BMI and BP were obtained. Participants were followed with BEM for 8 weeks with SMBP and daily text reminders. Results: Mean age was 58.7±12.8 years; mean BMI was 34.8±7.8; 63.9% were female; 25.7 % with previous diabetes diagnosis; 72% with obesity. Nonadherence significantly improved with mean KW adherence composite score change from 2.19 to 1.58 (p = 0.0001). Mean baseline SBP/DBP was 142.19/81.19; SBP decreased significantly by mean 10.5±20.0 mmHg (p = 0.0027) with no significant change in DBP. There was a non-significant decline in the average summary index of unhealthy days during the previous 30 days from 9.1 days to 6.8 days, change -2.3 ± 10.7 (p = 0.21). Conclusions: A novel approach combining cloud-based bluetooth SMBP transmission with BEM health communication significantly improved medication adherence and systolic BP in a predominantly NHB urban cohort without modifying existing pharmacotherapy. “Supported in part by U54 GM104940 from the National Institute of General Medical Sciences of NIH, which funds the LA Clinical and Translational Science Center. Content is solely the responsibility of the authors and does not necessarily represent official views of the NIH.”
Abstract 11444: Pattern of V <sub>E</sub> /VCO <sub>2</sub> Abnormalities in Chronic Thromboembolic Pulmonary Hypertension
Authors: Maria I Barillas Lara, Amanda Bonikowske, Ibolya Csecs, Robert Frantz, Thomas G Allison
Journal: Circulation (2022)

Introduction: Breathing efficiency (V E /VCO 2 slope or nadir) predicts mortality in heart failure (HF). The usual pattern of V E /VCO 2 vs. exercise intensity is a characteristic “shallow bowl” configuration allowing estimate of a V E vs. VCO 2 slope both in normal controls (C) and HF patients. Slope or nadir in HF is generally &gt; 33 vs. 25-30 in C. This pattern of V E /VCO 2 may not be true for other CV diseases. Objective: Compare V E /VCO 2 versus exercise time curves in patients with history of chronic thromboembolic pulmonary hypertension type 4 (PHT4) to HF and C referred for dyspnea on exertion. Methods: We identified 40 consecutive cases of PHT4 versus 40 HF and 40 C over the same age range retrospectively selected from our cardiopulmonary exercise test (CPX) database. V E /VCO 2 was plotted against exercise time (minutes of exercise ≈ METs), and groups were compared statistically for V E /VCO 2 and peak VO 2 by ANOVA followed with Tukey test, with significance set at P &lt; .05. Results: Figure shows higher V E /VCO 2 in PHT4 vs. HF and C with a different pattern vs. exercise intensity. In severe cases (example shown) V E /VCO 2 may increase continuously without plateau reaching peak values &gt; 80. There was statistically significant difference between peak VO 2 between C group vs HF and PHT4, but not among HF and PHT4, although V E /VCO 2 was significant different among the three groups. Age and sex was not different among them. Conclusion: V E /VCO 2 was elevated in PHT4 compared to HF and C. We interpret continuously increasing V E /VCO 2 as a marker of progressively worsening ventilation: perfusion mismatch. Interpretation of V E /VCO 2 in PHT4 cannot be based simply on nadir or slope as in HF, but a plot of the data should be visually examined to gain full understanding of the ventilatory abnormality.
Abstract 11452: EHR-Based Machine Learning Model Predicts Drug-Induced QT Prolongation With Superior Performance Compared to Clinical Risk Predictors
Authors: Linyuan Jing, Thomas Morland, Christopher Kelsey, Sushravya Raghunath, John Pfeifer, Jeffrey Ruhl, Brandon Fornwalt, Christopher M Haggerty
Journal: Circulation (2022)

Introduction: Many medications are associated with QTc prolongation (LQT). Current LQT predictors, including Tisdale and RISQ-PATH, have limited utility due to lack of generalizability to key use cases and modest model performance. A highly accurate LQT risk predictor utilizing data often available at the time of drug starts could broadly support LQT risk management. Hypothesis: An electronic health record (EHR)-based machine learning (ML) model is superior in predicting drug-induced LQT in a clinical population vs. Tisdale and RISQ-PATH. Methods: We identified all patients who began taking QT-prolonging medications (‘QTdrug’, per CredibleMeds) at Geisinger and had a follow-up 12-lead ECG within 1 year of medication start date while still on the drug. In case of multiple QTdrugs with overlapping dates, the last start date was used. Using 5-fold cross-validation, we trained an XGBoost ML model to predict LQT (QTc &gt;500 ms) within 1 year of QTdrug start date using EHR data as input, including 131 features across age, sex, smoking history, vitals, lab tests, comorbidities, baseline ECG metrics (within 3 years before drug start date) and QTdrug usage (ever on QTdrug, number of current QTdrugs). Results: QTdrug records were identified for 362,086 patients, and 6% had LQT within 1 year. The ML model demonstrated superior performance (Figure A) in predicting LQT (area under the curve (AUROC): 0.86, average precision score (AUPRC): 0.41) compared to RISQ-PATH (AUROC: 0.70, AUPRC: 0.19) and Tisdale (AUROC: 0.76, AUPRC: 0.21, calculated in a hospitalized subset N=113544). At the same specificity as RISQ-PATH (98%), the ML model had higher sensitivity (30% vs 10%) and positive predictive value (55% vs 29%). Similar comparisons were observed for Tisdale (Figure B). Conclusions: An EHR-based ML model outperforms commonly used risk calculators for predicting drug-induced LQT. This model can be used to stratify patients by risk of developing drug-induced LQT in a clinical setting.
Abstract 11074: A Model for Predicting Cardiovascular Events in Acute Decompensated Heart Failure Patients With Decreased Renal Function
Authors: Tomokazu Deguchi, miki sato, Noriko Kohyama, Kanako Fujita, sakura nagumo, Hiroshi Suzuki, Mio Ebato, MARI KOGO
Journal: Circulation (2022)

Background: The models for predicting cardiovascular events, including medication data such as dosage and the number of medications, have not been well studied. This study aimed to develop a model, including medication data, for predicting cardiovascular events within one year after discharge in acute decompensated heart failure (ADHF) patients with decreased renal function. Methods This study included 443 first-time admitted ADHF patients with decreased renal function in the Showa University Fujigaoka Hospital between January 2015 and December 2019. Decreased renal function was defined as an eGFR &lt; 60 mL/min/1.73 m 2 at discharge. The primary outcome was cardiovascular events (cardiovascular death and first heart failure rehospitalization) within one year after discharge. The model for predicting events was developed using predictive factors extracted by multivariate analysis. The cardiovascular events curves were visualized using the Kaplan-Meier method and estimated using a log-rank test. Results The incidence of cardiovascular events was 20.1%. By multivariate analysis, atrial fibrillation (AF), weight loss &lt; 5% during admission, brain natriuretic peptide (BNP) ≥ 200 pg/mL at discharge, polypharmacy (≥ 10 drugs), and beta-blockers use below the maintenance dosage were significantly associated with an increased risk of cardiovascular events. The hazard ratios of the five factors for the cardiovascular events were scored (AF, weight loss, polypharmacy, and beta-blockers dosage = 1 point; BNP = 2 points) and patients divided into three groups. The cardiovascular events rate in the high-risk (≥ 4 points) group was four times as high as the rate in the low-risk (≤ 2 point) group (one-year events rate: 41.0% vs 9.2%, p &lt; 0.001, Figure). Conclusions The developed model for cardiovascular events, including polypharmacy and beta-blockers dosage, will be useful for planning more aggressive and earlier management in ADHF patients with decreased renal function.